Increased risk of latent tuberculous infection among persons with pre-diabetes and diabetes mellitus

Abstract

SUMMARY SETTING Although diabetes mellitus (DM) is an established risk factor for active tuberculosis (TB) disease, little is known about the association between pre-DM, DM, and latent tuberculous infection (LTBI). OBJECTIVE To estimate the association between DM and LTBI. DESIGN We conducted a cross-sectional study among recently arrived refugees seen at a health clinic in Atlanta, GA, USA, between 2013 and 2014. Patients were screened for DM using glycosylated-hemoglobin (HbA1c), and for LTBI using the QuantiFERON®-TB (QFT) test. HbA1c and QFT results, demographic information, and medical history were abstracted from patient charts. RESULTS Among 702 included patients, 681 (97.0%) had HbA1c and QFT results. Overall, 54 (7.8%) patients had DM and 235 (33.8%) had pre-DM. LTBI was prevalent in 31.3% of the refugees. LTBI prevalence was significantly higher (P < 0.01) among patients with DM (43.4%) and pre-DM (39.1%) than in those without DM (25.9%). Refugees with DM (adjusted OR [aOR] 2.3, 95%CI 1.2–4.5) and pre-DM (aOR 1.7, 95%CI 1.1–2.4) were more likely to have LTBI than those without DM. CONCLUSION Refugees with DM or pre-DM from high TB burden countries were more likely to have LTBI than those without DM. Dysglycemia may impair the immune defenses involved in preventing Mycobacterium tuberculosis infection.

Prevalence and Determinants of Pre-diabetes and Latent Tuberculosis Infection Among Apparently Healthy Adults in Three Communities in Southern Nigeria

“…The prevalence of 8.2% for PDM in this study is similar to the reported 6.2% in Oke-Ogun region of Oyo state, Nigeria [32] and the 8.5% in Tamil-Nadu, India [33] but significantly different from the 13.8% recorded for periurban Uganda [34] and the 33.8% observed among recentlyarrived refugees in Atlanta, USA [35]. The high prevalence of 23.6% for LTBI in this work is also similar to the reported rates in other African countries, which ranged from 31.2% in Ethiopia [36] to 49.0% in urban Uganda [37] and 55.2% in South Africa [38]; while the American study reported 31.3% [35]. It is noteworthy that it was only the American study that simultaneously screened for both PDM and LTBI and used standardized techniques as employed in the present work.…”

“…The association between type-2 diabetes mellitus (DM) and pulmonary tuberculosis (TB) is well-documented (1,2,3,4,5,35), and it is recognized that most individuals do not just develop DM and TB overnight, they go through prolonged intermediate phase of pre-diabetes (PDM) and latent tuberculosis infection (LTBI) respectively. However, there is paucity of data on PDM and LTBI from the DM-and TB laden countries to inform recommendations on intervention in those settings.…”

Diabetes and Tuberculosis

“…However, this difference was not significant after controlling for confounders (81). Among refugees in Atlanta, US, there was a higher proportion of LTBI among those with pre-DM or DM (versus non-DM) when using QFT-IT (84) Thus, the few available studies do not indicate a clear compromise due to DM, but studies are needed to understand the individual contribution of DM and its synergy with additional host factors (older age, gender, BMI) that can collectively influence assay sensitivity.…”

Prediabetes is associated with the modulation of antigen-specific Th1/Tc1 and Th17/Tc17 responses in latent Mycobacterium tuberculosis infection

“…PDM has been shown recently to be associated with an increased risk of latent TB infection [7], to be associated with pulmonary TB in individuals with respiratory symptoms [8], and to be associated with dysregulated cytokine responses in pulmonary TB [9]. In addition, the prevalence of PDM has been reported to be as high as 25% in individuals with active TB [10].…”